Lowering blood pressure effect of Apium graviolens (seledri) and Orthosipleon stamineus benth (kumis kucing) in mild and moderate hypertension
VoL I
l,
No 4, October
-
BLood pressure and
December 20A2
traditional medicine
195
Lowering blood pressure effect of Apium graviolens (seledri) and
Orthosipleon stamineus benth (kuwîs kucing) in mild and rnoderate
hypertension
Fadilah Supari
Abstrak
Indonesia Apiurn graviolens (seledri) dan Orthosiphon stamineus benth (kumis kucing) sudah lama dikenal sebagai bahan obat
tradisional yang dipercaya dapat menurunkan telcanan darah. Pada saat ini sudah beredar di pasaran [ndonesia kemasan fitofarmaka
yang berisi kombinasi antara dLa bahan tersebut. OIeh lurena itu perlu dilalatkan penelitian untuk mengetahui efektifitas dan efek
samping terhadap penderita hipertensi ingan dant sedang. Penelitian dilakukan di daerah Monica Jakarta di Jakarta Selatan 3 Juli
ta hipertens^i ringan dan sedang dengan randomized double blind contolled tial. Kelompok
sampai 29 Oktober
(Tensigarf yang beisi seledi dan kumis kucing) sebanyak 3 x 250 mg, sedangkan kelompok
p"rto*o (72 subjek)
kedua (70 sttbjek) diberikan Amlodipine I x 5 mg. Pengamatan dilakukan selnma 12 minggu dan parameter yang diukur adalah tekanan
darah sistolik maupun diastolik kadar tipid plasmn, kadar gula darah sebelum dan sesudah perlakuan, serta kndar elekrrolit tiap dtta
minggu perlahnn. Hasil penelitian menunjuklam bahwa pemberian ftofarruka selama dua belas minggu menurunlcan telanan darah
sistolik (TDS) maupun diastolik (TDD) setara dengan Amlodipine (TDS 24,72 ! 1.63 mmHg vs 26,27 + 2.18 mmHg, P > 0,05; TDD
10,00 t 0.96 mmHg vs 9,49 t 1.37 mmHg P > 0.05). Di sarnping itu pemberian ftofarmal 0.05). Phytopharmaca treatment for 12 weel 0.050 based on the results of significant
statistical tests. AII statistical tests were based on two
tail tets. All caculation were performed by using SPPS
software version 10.
Table 1. Some characteristics of subjects
Phytopharmaca Amlodipine
(N=72)
0.922
Maie
54
52
Female
t8
18
No
38
40
Yes
34
30
No
29
40
Yes
43
30
No
29
45
Yes
43
18
6Z
63
Smoking habits
participated in this study tbr each groups. During the
study period there were 18 subjects discontinued the
study (eight subjects from the phytopharmaca group,
and 10 subjects belonged to Amlodipine
group).
discontinuing this
0.1
Family history
Diabetes
mellitus type
l7
0.423
0.414
II
No
'l
10
Yes
Table
2.
Some characteristics ofsubjects
Phyopharmaca Amlodipine
(N=72)
SD
Mean +
Height (cm)
Blood pressure on entry
Systolic (mmHg)
Diastolic (mrnHg)
t.26
0378
61.40r r.32
6l.t8J
1.47
0.913
157.48 + 0.85
t58.72+
163.68
+
+
1.05
1.64
96.67 + 0.77
Laboratory (mg/dl)
Total cholesterol
reasons.
205.81 + 4.66
4t.62+
HDL
LDL
r31.07+4.35
Triglyceride
164.00 + 8.29
Fasting blood sugar
101,99 + 3.76
SGOT
20.96
SCPT
2325+ t.66
Electrolytes (mmoUdt)
Kalium
1.47
+ 1.00
4.53 + 0.08
ro4.59
Chloride
t0
42
2 l3 + 0 06
Magnesium
t40.98 + 0.26
Natrium
(N=70)
Mean + SD
61.03t
59.60
Physical performance
Body weight (kg)
There were several reasons for
study, such as: (l) The subjects could not afford the
side effect; (2) The subjects felts that the medicines
were not suitable; (3) The subjects moved to other
address and could not be followed-up; (4) Other
Table I shows that phytopharmaca and Amlodipine
groups were similarly distributed with respect to
gender, smoking habits, family history. Furthermore,
more phytopharmaca group than Amlodipine group
who had dislipidemia (P = 0.117).
0.600
Dislipidemia
Age (years)
At the beginning of the study eighty subjects
(N=70)
Gender
Ethical Committee of the National Cardiac Center
Harapan Kita approved this study.
RESULTS
197
0.9'7
0.340
t65.76+2.04
0460
96.69
0.825
+
t.t8
4.29 0.090
t.39 0.971
120.08 + 3.32 0.033
186.54 + 17.3 0.270
105.29 + 4.83 0.455
2I ;77 + 0 88 0.254
22.35 + 2-t3 0.9't9
196.06 +
42.02+
4.53+010 0.28'7
0.48 0.714
2.11+005 0.860
140.88 + 0.28 0794
104.07 +
electrolytes findings. Tensgard@ group had a significantly
Table 3 and Table 4 show that diastolic and systolic
blood pressure gradually decreased in both groups.
Systolic and diastolic blood pressure were prominent
different decreases between two groups were noted
(P = 0.033).
respectively).
In addition Table 2 shows that the two groups were
also similarly distributed with respect of age, blood
pressure on entry, laboralory (except for LDL), and
higher LDL level compared with Amlodipine group
during week
of 4
and
6 (P =
0.027 and 0.078
'!
I
I
198
Supari
Table
Med J Indones
3.
Systolic blood pressure on entry and the decrease by week of treatment
72)
from
the entry
Amlodipine (N = 70)
Phytopharmaca (N =
Systolic blood
Week
pressure
Decrease
Systotic
blood
measurement
Mean + SD
Week 0
163.68 + 1.64
Week 2
149.51+ 1.90
Week 4
149.79
Week 6
t43.54
r
Mean + SD
t
!
1.60
r3.89
20.t4
t.79
20.90
t
+ 1.14
139.i5 + 1.18
22.99
Week
8
Week
l0
140.69
Week
12
Tabte
4. Diastolic blood
N1ean
+ SD
149.41!2.30
*
Mean
SD
0.433
!
t.79
0.027
0.180
!r.39
24.49 + 1.9'7
0.220
+
1.53
25.42 + 2.t3
0.371
139.49 !1.',73
26.2'7 + 2.18
0.563
146.02
t.78
14t.67
2.08
t41.27
!1.'t3
140.34
24:12 + t.63
! t.96
tt.6l
16.36 + 2.05
23.83 t2.11
1.86
19.7 5
pressure on entry and the decrease by week of treatment
Amlodipine (N = 70)
Phytopharmaca (N = 72)
Week
the entry
measurement
165.76 + 2.04
14.17 È 1.88
1.36
!
t42.78 !
Decrease tiom
pressure
Diastolic blood
pressure
Decrease from
enty
the
blood Decrease from
pressure ' the entry
Diastolic
meâsurement
Mean + SD
Mean + SD
Week 0
96.67 + 0.71
Week 2
91 .39
Week 4
91.04
Week 6
89.10 + 0.81
Week 8
88.26
+
Week 10
87 .22
+ 0.62
9.44
Week 12
86.76
!0.82
10.00
t 0.86
t 0.87
1.06
t
Mean +
SD
0.99
91.27
+
!1.09
1.09
88.05
+
7.57
+
0.98
86.58
+
r 0.88
8.40
1.06
t
+
Mean
t
SD
96.69 +1.18
5.63
5.28
measurement
0.89
0.96
Among phytopharmaca subjects, at the end of lhe
study systolic blood pressures lhe average decreased
was 24.72 mrnHg. This is almost the same figure
among Amlodipine subjects (26.27 mmHg). The same
decreases were also noted for diastolic blood
pressures. These means both drugs were suitable to
control mild and moderate hypertension. It can be
concluded that there was no difference belween
phytopharmaca and Amlodipine to control mitd and
moderate hypertension.
Table 5 indicates that there were no significant
changes in term of laboratory findings on electrolytes,
1.18
5.42+ t.t1
0.924
8.64
0.078
+ 1.33
10.17 + 1.18
t 0.89
86.61 t 0.99
10.08
87.20 + 0.88
9.49
86.78
9.92+
r
+
1.39
0.090
0.381
1.36
0.685
t.37
0.7 56
plasma lipids, and fasting blood sugar between at the
entry and at the end of the study on both groups.
Table 6 shows that the most frequent side effect was
dizziness. For each groups revealed there were 14
(197o) subjects who experience of having dizziness.
The other side effects were considered to be rare, and
the was no significant difference between two groups.
There was one subject who Cevelops TLA, (Temporary
lschemic Attack) among Tensgard@ group. In addition,
there was noted one subject among Amlodipine group
who experience of having unstable angina. Ihe two
cases could be managed by nitrate treatments.
Vol I l, No 4, October
-
Blood pressure antl traditional
December 2002
medicine
199
Table 5. Change of electrolyte, plasma lipid, and fasting blood sugar
Phytopharmaca
On
4.53
Kalium
Magnesium
Natrium
Total cholesterol
HDL
LDL
Triglyceride
Fastins blood su
6.
The end
0.08
0.42
i
0.06
2.13
140.98 + 0.26
205.81+ 4.66
4t.62+ t.47
13t.0 t 4.35
164.00 + 8.29
t0r.99 t 3.76
t04.59 +
Chloride
Table
r
(N=72)
4.17
r
0.06
+ 0.33
2.14t 0.03
103.89
Amlodipine (N=70)
On
+ 0.10
104.07 + 0.48
2.11i 0.05
4.35
t 0.25 140.88 t 0.28
5.54 196.06+ 4.29
42.02t1.39
42.33 + 1.22
145.46+ 4.98 120.08 + 3.32
139.64 + 7.81 186.54 + 17.30
106.19 i 4.30 105.29 +4.83
The end
4.07
!
104.06
2.16
0.0'l
+
r
t
141.50
141.58
203.79!
42.851
Some side effects
133.12
152.77
108.46
0.26
4.39
0.643
1.58
0.935
0.03
215j5+
!
0.782
0.314
0.469
0.92'l
0.29
3.79
0.797
+ 13.19
0.523
0.864
t
4.09
Apiosæglukosa-
Phytopharmaca AmlodiPine
(N=72)
(N=70)
P
Dizziness
Faint
t4
14
J
1
0.934
0.324
Libido decrease
Tibial edema
I
I
0.984
0
0
Flushing on lace
I
0
0.322
Nausea
1
4
0.162
Frequent urinating
0
0
Sleepy
I
2
0.543
Tachycardia
Bradicardia
2
2
0.9'17
0
0
,r,*o#'ËHn""l
DISCUSSION
s?ledri f.or 74Vo and extract of Orthosiphon stamineus
(kumis kucing) for llVo, and added with lactose,
Phytopharmaca is a development of traditional medicine.
The basic difference between traditional medicine and
phytopharmaca is the active chemical component on
phylopharmaca is quantitatively known, whereas on the
iraditional medicine the only known is source of extract'6
magnesium stearat, and texaPon.
Furthermore, the other important things on phytopharmaca there are phase I, II, and III clinical trial
evidence. On the other hand, the traditional medicine is
Apium graviolens leaf contains atsiri o1l, protein, calcium, phosphate salt mineral, vitamin A, B and C. The
stick leaf of and the seed contain apiin and apigenin.s
One capsule of Tensigard@ consisted of active
substance of apigenin for 11.04 mg and Orthosiphon
based on empiricâl experiences or desceridence belief.
stamineus benth 8.4 mg.
In this study the phytopharmaca is a
Previous reportss'tO apigenin has an effect for aorta
vasorelaxation or vasodilalation among isolated rats
by mechanism contraction inhibition by means of
domestic
Indonesian product by gathering traditional medicines
to be a created phytopharmaca named "Tensigard@ ".
In fact this phytopharmaca has been available in the
markel as a traditional medicine Çamu)- This
phytopharmaca needs a clinical trial.
Tensigard@ is a phytopharmaca consisted of exlract of
Apium graviolens or in Indonesian language is called
.ul"iu-
released (calcium antagonist),e-r0 The other
report6 reported that apigenin has an effect to inhibit
protein kinase C or has an effect protein Kinase-C
inhibitor on rat aorta. This inhibition of cyclic
nucleotide phospo-diesterase decreases calcium
release.
ll
200
Supari
Med J Indanes
Therefore, apigenin has been proved to have a similar
Even though the phytopharmaca contains diuretics, it
effect with Calcium channei bloker.e-rt Vy'hereas,
Orthosiphon stamineus extiact contains Methylripariochromene p (MRC). The MRC has a vasodilato effect, lowering cardiac output. In addition it
has a iuresis efect.'' This effect is similar with beta
is not proved that hypokalemia occurred on the
phytopharmaca treatment. This means that the
predicted the eft'ect of calcium antagonist was more
dominant compared with diuretic effect. In addition,
the plasma lipid leveis as well as blood sugar level did
blocker efect.r2 Therefore, the phytopharmaca has a
similar effect with calcium channel blocker, a mild
beta blocker and diuretic. These three effects are
Iowering blood pressure. This study reveals that
systolic as well as diastolic blood pressures for both
groups (phytopharmaca and Amlodipine) decreased,
not change significantly.
This study noted that on both groups when SBP blood
reached 130-140 mmHg and DBP reached 90 - 80
mmHg, even though the treatment were continued,
there was drastic blood pressure decrease or
hypotension. The combination effect of calcium
and there was no significant difference.
The slope of systolic and diastolic blood
blocker, beta-blocker and mild diuretic for The
phytopharmaca seems to be tolerated to decrease
blood pressure in accordance with Amlodipine.
pressure
decreased among phytopharmaca was not as sharp as
the Amlodipine group. However, it reached significant
results at week 12. This means that phytopharmaca is
relevant to control mrld and moderate hypertension.
In
conclusion, this trial revealed that the phytopharmaca, which conlains Apium graviolens and
Orthosiphon stamineus benth, lowered systolic and
diastolic blood pressure equivalent with Amlodipine
among mild and moderate hypertensive subjects.
Diuretic effect for this phytophurmucu"-''t was not
prominent. There was no diuretic complaint from ihe
study subjects. In addition, there was no diuresis
effect toward blood electrolyte profiles. The sàme
results were also noted for plasma lipidsla'15 Eft'ect on
plasma lipids is similar with the previous report on
rats.15 The phytopharmaca had no significant effects
on blood sugar. This means there would be nor
REFERENCES
1.
years [Indonesian]. Jakarta: The Team; 2000.
hyperglicemia or hypoglycemia.
The phytopharmaca had no clear beta-blocker effect.
This can be seen that there were only a small number
of subjecls who had a decreased libido, bradicardia,
etc. among the two groups.
2
detection, evaluation and treatment
'
of high blood
Instinrte;1997.
Gadjah Mada University. Report on preclinical trial on
Tensigard@ [Indonesian]. Yogyakarta: The University
Press;2001.
Ministry
to be TIA
among Amlodipine
group. Further anamnesis revealed that two years the
of
Health
of the
Republic
of
ft.rdonesie
findonesian]. Herbal preparate [Indonesian]. Jakarta: The
Ministry; 2000.
Chan EC, Pannahpech P, Woodman OL. Relaxation to
subject suffered several limes from TIA.
flavones and flavonols in rat isolated thoracic aorta:
Mechanism of action and structure-activity relationship. J
Whereas one subject who had unstable angina among
phytopharmaca group revealed that this is the first
time. The sLrbject had several risk factors, such as a
6.
hospitalization and he had heparinization and nitrate
in accordance wich the study protocol.
8
fitty year-old male, heavy smoker and had
dislipidemia. It seems that unstable angina was not
related to the phytopharmaca. He had a four-day
Transient ischemic altack as well as angina pecloris
were lound on the second and third day alter
discontinuation of hypertensive treatment.
National Heart, Lung and Blood Pressure Instihrte. The
sixth report of the joint national committee on prevention,
pressure. Nat Inst Hlth Publ No. 98-4084. Bethesda: The
There was no tibial edema and tachicardia found. One
subject was found
Monica Jakarta Team. Report on MONICA survey III.
The risk and fall of cardiovascular risk factors after 12
Cardiovascular Pharmacolog y 2000:3 5 :326-33
Chang HN, But PPH. Pharmacology and applications ol
Chinese materia-[. Medica vol 2. Singapore: World
Scienlific Publ Co Ltd; 1986.
Ministry of Health of the Republic of Indonesia. Guidance
on herbal preparate [Indonesian]. lst edition. Jakarta: The
Ministry; 2000.
Englert J, Harnischfeger C. Diuretic action aqueous
orthosiphon extract in rats. Planta Med 1992;58:237-8.
Galyr-rteva G[, Benson NA. Comparative evalur-ion ol the
diurelic activity of leaves and leaf tissue culture biomass
of Orthosiphon stamineus benth. Rastitel'Nye Resursy
I
990;26:559-65.
Vol I
l,
No 4, October
-
10. Ko FN, Huang TF, Teng CM. Biochemical
acta.
BLood pressure and
December 2002
biophysiotogy 13.
Taipei: National Taiwan University; 199 l.
Ll. Ko FN.
Vasodilatory action mechanisms
of apigenin
Bull
1999;20: 1083-8.
medicine
201
Sudarsono. Herb plant [Indonesian]. Yogyakarta: Gajah
Mada University; 1995.
14. Monica Team. Report on MONICA Survey II.
isolated from Apium graveolens in rat thoracic âorta.
15.
BiochimBiophys Acta 1991;1115:69-'74.
12. Mitsubara T, Bohgaki T, Watarai M. Antihypertensive
âctions of methylripariochromene A from Orthosiphon
aristatus, an Indonesian traditional medicinal plant. Biol
Pharm
traditional
TheTeam:1993.
Jakarta;
Tsi D. Effects of aqueous celery (Apium graveolens)
extract on lipid parameters of rats fed a high fat diet.
PlantaMed. 1995;61:18-21.
l,
No 4, October
-
BLood pressure and
December 20A2
traditional medicine
195
Lowering blood pressure effect of Apium graviolens (seledri) and
Orthosipleon stamineus benth (kuwîs kucing) in mild and rnoderate
hypertension
Fadilah Supari
Abstrak
Indonesia Apiurn graviolens (seledri) dan Orthosiphon stamineus benth (kumis kucing) sudah lama dikenal sebagai bahan obat
tradisional yang dipercaya dapat menurunkan telcanan darah. Pada saat ini sudah beredar di pasaran [ndonesia kemasan fitofarmaka
yang berisi kombinasi antara dLa bahan tersebut. OIeh lurena itu perlu dilalatkan penelitian untuk mengetahui efektifitas dan efek
samping terhadap penderita hipertensi ingan dant sedang. Penelitian dilakukan di daerah Monica Jakarta di Jakarta Selatan 3 Juli
ta hipertens^i ringan dan sedang dengan randomized double blind contolled tial. Kelompok
sampai 29 Oktober
(Tensigarf yang beisi seledi dan kumis kucing) sebanyak 3 x 250 mg, sedangkan kelompok
p"rto*o (72 subjek)
kedua (70 sttbjek) diberikan Amlodipine I x 5 mg. Pengamatan dilakukan selnma 12 minggu dan parameter yang diukur adalah tekanan
darah sistolik maupun diastolik kadar tipid plasmn, kadar gula darah sebelum dan sesudah perlakuan, serta kndar elekrrolit tiap dtta
minggu perlahnn. Hasil penelitian menunjuklam bahwa pemberian ftofarruka selama dua belas minggu menurunlcan telanan darah
sistolik (TDS) maupun diastolik (TDD) setara dengan Amlodipine (TDS 24,72 ! 1.63 mmHg vs 26,27 + 2.18 mmHg, P > 0,05; TDD
10,00 t 0.96 mmHg vs 9,49 t 1.37 mmHg P > 0.05). Di sarnping itu pemberian ftofarmal 0.05). Phytopharmaca treatment for 12 weel 0.050 based on the results of significant
statistical tests. AII statistical tests were based on two
tail tets. All caculation were performed by using SPPS
software version 10.
Table 1. Some characteristics of subjects
Phytopharmaca Amlodipine
(N=72)
0.922
Maie
54
52
Female
t8
18
No
38
40
Yes
34
30
No
29
40
Yes
43
30
No
29
45
Yes
43
18
6Z
63
Smoking habits
participated in this study tbr each groups. During the
study period there were 18 subjects discontinued the
study (eight subjects from the phytopharmaca group,
and 10 subjects belonged to Amlodipine
group).
discontinuing this
0.1
Family history
Diabetes
mellitus type
l7
0.423
0.414
II
No
'l
10
Yes
Table
2.
Some characteristics ofsubjects
Phyopharmaca Amlodipine
(N=72)
SD
Mean +
Height (cm)
Blood pressure on entry
Systolic (mmHg)
Diastolic (mrnHg)
t.26
0378
61.40r r.32
6l.t8J
1.47
0.913
157.48 + 0.85
t58.72+
163.68
+
+
1.05
1.64
96.67 + 0.77
Laboratory (mg/dl)
Total cholesterol
reasons.
205.81 + 4.66
4t.62+
HDL
LDL
r31.07+4.35
Triglyceride
164.00 + 8.29
Fasting blood sugar
101,99 + 3.76
SGOT
20.96
SCPT
2325+ t.66
Electrolytes (mmoUdt)
Kalium
1.47
+ 1.00
4.53 + 0.08
ro4.59
Chloride
t0
42
2 l3 + 0 06
Magnesium
t40.98 + 0.26
Natrium
(N=70)
Mean + SD
61.03t
59.60
Physical performance
Body weight (kg)
There were several reasons for
study, such as: (l) The subjects could not afford the
side effect; (2) The subjects felts that the medicines
were not suitable; (3) The subjects moved to other
address and could not be followed-up; (4) Other
Table I shows that phytopharmaca and Amlodipine
groups were similarly distributed with respect to
gender, smoking habits, family history. Furthermore,
more phytopharmaca group than Amlodipine group
who had dislipidemia (P = 0.117).
0.600
Dislipidemia
Age (years)
At the beginning of the study eighty subjects
(N=70)
Gender
Ethical Committee of the National Cardiac Center
Harapan Kita approved this study.
RESULTS
197
0.9'7
0.340
t65.76+2.04
0460
96.69
0.825
+
t.t8
4.29 0.090
t.39 0.971
120.08 + 3.32 0.033
186.54 + 17.3 0.270
105.29 + 4.83 0.455
2I ;77 + 0 88 0.254
22.35 + 2-t3 0.9't9
196.06 +
42.02+
4.53+010 0.28'7
0.48 0.714
2.11+005 0.860
140.88 + 0.28 0794
104.07 +
electrolytes findings. Tensgard@ group had a significantly
Table 3 and Table 4 show that diastolic and systolic
blood pressure gradually decreased in both groups.
Systolic and diastolic blood pressure were prominent
different decreases between two groups were noted
(P = 0.033).
respectively).
In addition Table 2 shows that the two groups were
also similarly distributed with respect of age, blood
pressure on entry, laboralory (except for LDL), and
higher LDL level compared with Amlodipine group
during week
of 4
and
6 (P =
0.027 and 0.078
'!
I
I
198
Supari
Table
Med J Indones
3.
Systolic blood pressure on entry and the decrease by week of treatment
72)
from
the entry
Amlodipine (N = 70)
Phytopharmaca (N =
Systolic blood
Week
pressure
Decrease
Systotic
blood
measurement
Mean + SD
Week 0
163.68 + 1.64
Week 2
149.51+ 1.90
Week 4
149.79
Week 6
t43.54
r
Mean + SD
t
!
1.60
r3.89
20.t4
t.79
20.90
t
+ 1.14
139.i5 + 1.18
22.99
Week
8
Week
l0
140.69
Week
12
Tabte
4. Diastolic blood
N1ean
+ SD
149.41!2.30
*
Mean
SD
0.433
!
t.79
0.027
0.180
!r.39
24.49 + 1.9'7
0.220
+
1.53
25.42 + 2.t3
0.371
139.49 !1.',73
26.2'7 + 2.18
0.563
146.02
t.78
14t.67
2.08
t41.27
!1.'t3
140.34
24:12 + t.63
! t.96
tt.6l
16.36 + 2.05
23.83 t2.11
1.86
19.7 5
pressure on entry and the decrease by week of treatment
Amlodipine (N = 70)
Phytopharmaca (N = 72)
Week
the entry
measurement
165.76 + 2.04
14.17 È 1.88
1.36
!
t42.78 !
Decrease tiom
pressure
Diastolic blood
pressure
Decrease from
enty
the
blood Decrease from
pressure ' the entry
Diastolic
meâsurement
Mean + SD
Mean + SD
Week 0
96.67 + 0.71
Week 2
91 .39
Week 4
91.04
Week 6
89.10 + 0.81
Week 8
88.26
+
Week 10
87 .22
+ 0.62
9.44
Week 12
86.76
!0.82
10.00
t 0.86
t 0.87
1.06
t
Mean +
SD
0.99
91.27
+
!1.09
1.09
88.05
+
7.57
+
0.98
86.58
+
r 0.88
8.40
1.06
t
+
Mean
t
SD
96.69 +1.18
5.63
5.28
measurement
0.89
0.96
Among phytopharmaca subjects, at the end of lhe
study systolic blood pressures lhe average decreased
was 24.72 mrnHg. This is almost the same figure
among Amlodipine subjects (26.27 mmHg). The same
decreases were also noted for diastolic blood
pressures. These means both drugs were suitable to
control mild and moderate hypertension. It can be
concluded that there was no difference belween
phytopharmaca and Amlodipine to control mitd and
moderate hypertension.
Table 5 indicates that there were no significant
changes in term of laboratory findings on electrolytes,
1.18
5.42+ t.t1
0.924
8.64
0.078
+ 1.33
10.17 + 1.18
t 0.89
86.61 t 0.99
10.08
87.20 + 0.88
9.49
86.78
9.92+
r
+
1.39
0.090
0.381
1.36
0.685
t.37
0.7 56
plasma lipids, and fasting blood sugar between at the
entry and at the end of the study on both groups.
Table 6 shows that the most frequent side effect was
dizziness. For each groups revealed there were 14
(197o) subjects who experience of having dizziness.
The other side effects were considered to be rare, and
the was no significant difference between two groups.
There was one subject who Cevelops TLA, (Temporary
lschemic Attack) among Tensgard@ group. In addition,
there was noted one subject among Amlodipine group
who experience of having unstable angina. Ihe two
cases could be managed by nitrate treatments.
Vol I l, No 4, October
-
Blood pressure antl traditional
December 2002
medicine
199
Table 5. Change of electrolyte, plasma lipid, and fasting blood sugar
Phytopharmaca
On
4.53
Kalium
Magnesium
Natrium
Total cholesterol
HDL
LDL
Triglyceride
Fastins blood su
6.
The end
0.08
0.42
i
0.06
2.13
140.98 + 0.26
205.81+ 4.66
4t.62+ t.47
13t.0 t 4.35
164.00 + 8.29
t0r.99 t 3.76
t04.59 +
Chloride
Table
r
(N=72)
4.17
r
0.06
+ 0.33
2.14t 0.03
103.89
Amlodipine (N=70)
On
+ 0.10
104.07 + 0.48
2.11i 0.05
4.35
t 0.25 140.88 t 0.28
5.54 196.06+ 4.29
42.02t1.39
42.33 + 1.22
145.46+ 4.98 120.08 + 3.32
139.64 + 7.81 186.54 + 17.30
106.19 i 4.30 105.29 +4.83
The end
4.07
!
104.06
2.16
0.0'l
+
r
t
141.50
141.58
203.79!
42.851
Some side effects
133.12
152.77
108.46
0.26
4.39
0.643
1.58
0.935
0.03
215j5+
!
0.782
0.314
0.469
0.92'l
0.29
3.79
0.797
+ 13.19
0.523
0.864
t
4.09
Apiosæglukosa-
Phytopharmaca AmlodiPine
(N=72)
(N=70)
P
Dizziness
Faint
t4
14
J
1
0.934
0.324
Libido decrease
Tibial edema
I
I
0.984
0
0
Flushing on lace
I
0
0.322
Nausea
1
4
0.162
Frequent urinating
0
0
Sleepy
I
2
0.543
Tachycardia
Bradicardia
2
2
0.9'17
0
0
,r,*o#'ËHn""l
DISCUSSION
s?ledri f.or 74Vo and extract of Orthosiphon stamineus
(kumis kucing) for llVo, and added with lactose,
Phytopharmaca is a development of traditional medicine.
The basic difference between traditional medicine and
phytopharmaca is the active chemical component on
phylopharmaca is quantitatively known, whereas on the
iraditional medicine the only known is source of extract'6
magnesium stearat, and texaPon.
Furthermore, the other important things on phytopharmaca there are phase I, II, and III clinical trial
evidence. On the other hand, the traditional medicine is
Apium graviolens leaf contains atsiri o1l, protein, calcium, phosphate salt mineral, vitamin A, B and C. The
stick leaf of and the seed contain apiin and apigenin.s
One capsule of Tensigard@ consisted of active
substance of apigenin for 11.04 mg and Orthosiphon
based on empiricâl experiences or desceridence belief.
stamineus benth 8.4 mg.
In this study the phytopharmaca is a
Previous reportss'tO apigenin has an effect for aorta
vasorelaxation or vasodilalation among isolated rats
by mechanism contraction inhibition by means of
domestic
Indonesian product by gathering traditional medicines
to be a created phytopharmaca named "Tensigard@ ".
In fact this phytopharmaca has been available in the
markel as a traditional medicine Çamu)- This
phytopharmaca needs a clinical trial.
Tensigard@ is a phytopharmaca consisted of exlract of
Apium graviolens or in Indonesian language is called
.ul"iu-
released (calcium antagonist),e-r0 The other
report6 reported that apigenin has an effect to inhibit
protein kinase C or has an effect protein Kinase-C
inhibitor on rat aorta. This inhibition of cyclic
nucleotide phospo-diesterase decreases calcium
release.
ll
200
Supari
Med J Indanes
Therefore, apigenin has been proved to have a similar
Even though the phytopharmaca contains diuretics, it
effect with Calcium channei bloker.e-rt Vy'hereas,
Orthosiphon stamineus extiact contains Methylripariochromene p (MRC). The MRC has a vasodilato effect, lowering cardiac output. In addition it
has a iuresis efect.'' This effect is similar with beta
is not proved that hypokalemia occurred on the
phytopharmaca treatment. This means that the
predicted the eft'ect of calcium antagonist was more
dominant compared with diuretic effect. In addition,
the plasma lipid leveis as well as blood sugar level did
blocker efect.r2 Therefore, the phytopharmaca has a
similar effect with calcium channel blocker, a mild
beta blocker and diuretic. These three effects are
Iowering blood pressure. This study reveals that
systolic as well as diastolic blood pressures for both
groups (phytopharmaca and Amlodipine) decreased,
not change significantly.
This study noted that on both groups when SBP blood
reached 130-140 mmHg and DBP reached 90 - 80
mmHg, even though the treatment were continued,
there was drastic blood pressure decrease or
hypotension. The combination effect of calcium
and there was no significant difference.
The slope of systolic and diastolic blood
blocker, beta-blocker and mild diuretic for The
phytopharmaca seems to be tolerated to decrease
blood pressure in accordance with Amlodipine.
pressure
decreased among phytopharmaca was not as sharp as
the Amlodipine group. However, it reached significant
results at week 12. This means that phytopharmaca is
relevant to control mrld and moderate hypertension.
In
conclusion, this trial revealed that the phytopharmaca, which conlains Apium graviolens and
Orthosiphon stamineus benth, lowered systolic and
diastolic blood pressure equivalent with Amlodipine
among mild and moderate hypertensive subjects.
Diuretic effect for this phytophurmucu"-''t was not
prominent. There was no diuretic complaint from ihe
study subjects. In addition, there was no diuresis
effect toward blood electrolyte profiles. The sàme
results were also noted for plasma lipidsla'15 Eft'ect on
plasma lipids is similar with the previous report on
rats.15 The phytopharmaca had no significant effects
on blood sugar. This means there would be nor
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2
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6.
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8
fitty year-old male, heavy smoker and had
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